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 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
07.01  Drugs used in obstetrics
07.01.01  Prostaglandins and oxytocics
Carboprost (Hemabate®)
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Red

Secondary care use only. 

 
   
Dinoprostone (Prostin E2®)
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Red

Secondary care use only. 

Note: Prostin E2 Vaginal Gel and Vaginal Tablets are not bioequivalent.

 
   
Ergometrine Maleate
(Ergometrine)
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Red

Secondary care use only. 

 
   
Ergometrine Maleate and Oxytocin (Syntometrine®)
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Red

Secondary care use only. 

 
   
Oxytocin (Syntocinon®)
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Formulary
Red

Secondary care use only. 

 
   
07.01.01.01  Drugs affecting the ductus arteriosus
07.01.01.01  Maintenance of patency
07.01.01.01  Closure of ductus arteriosus to top
Ibuprofen (NeoProfen® injection)
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Unlicensed Drug Unlicensed
Red

Secondary care use in SCBU only.

 
   
Indometacin
(Injection)
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Unlicensed Drug Unlicensed
Red

Secondary care use only for closure of Patent Ductus Arteriosus (PDA) in premature neonates.

 
   
07.01.02  Mifepristone
Mifepristone (Mifegyne®)
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Formulary
Red

Secondary care use only. 

 
Link  NICE Evidence summary: Mifepristone for induction of labour in late intrauterine fetal death
   
07.01.03  Myometrial relaxants
Salbutamol IV
(Obstetrics)
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Formulary
Red

Secondary care use only. 

 
   
Terbutaline
(Obstetrics)
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Formulary
Red

Secondary care use only. 

 
   
07.01.04  Drugs for preterm labor
07.02  Treatment of vaginal and vulval conditions
07.02.01  Preparations for vaginal and vulval changes to top
07.02.01  Topical HRT
Oestrogens, Topical (Gynest® 0.01%)
(Estriol)
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First Choice
Green

Vaginal cream for HRT treatment, in line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

 
Oestrogens, Topical (Vagifem®)
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First Choice
Green

First line topical vaginal oestrogen treatment for HRT, in line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

 
Oestrogens, Topical (Estring®)
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Second Choice
Green

Alternative option if allergic to other topical products, dexterity problems with applicators or patient preference, in line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

 
   
Oestrogens, Topical (Ovestin®)
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Formulary
Green
 
   
07.02.01  Non-hormonal preparations
07.02.02  Vaginal and vulval infections
07.02.02  Fungal infections
Clotrimazole
(Pessary/ PV cream)
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First Choice
Green

For the treatment of vaginal candidiasis and trichomoniasis, in line with Guidelines for Antibiotic Prescribing in the Community 2018.

 
Fluconazole
(Oral)
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First Choice
Green

For the treatment of vaginal candidiasis and recurrent infections, in line with Guidelines for Antibiotic Prescribing in the Community 2018.

 
Miconazole (Gyno-Daktarin®)
(vaginal cream)
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First Choice
Green

One of first line options for treatment of vaginal candidiasis in non-pregnant women.

First line treatment of vaginal candidiasis in pregnant women, in line with Guidelines for Antibiotic Prescribing in the Community 2018.

 
07.02.02  Other vaginal infections to top
Clindamycin 2% (Dalacin®)
(Cream)
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Formulary
Green

For the treatment of bacterial vaginosis, in line with Guidelines for Antibiotic Prescribing in the Community 2018.

 
   
Metronidazole 0.75% (Zidoval®)
(Vaginal gel)
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Restricted Drug Restricted
Brown

For the treatment of bacterial vaginosis, in line with Guidelines for Antibiotic Prescribing in the Community 2018.

Metronidazole is reserved to patients allergic to clindamycin. 

 
   
07.03  Contraceptives
07.03.01  Combined hormonal contraceptives
Ethinylestradiol 20 mcg / norethisterone 1mg (Loestrin 20®)
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First Choice
Green

Monophasic low strength (21 day preparation).

Loestrin 20® is the most cost-effective monophasic low strength (21 day) preparation.

 
Ethinylestradiol 30mcg / levonorgestrel 150mcg (Rigevidon®, Microgynon 30®, Levest®, Ovranette®)
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First Choice
Green

Monophasic standard strength combined oral contraceptive (21 day preparation).

Levest® is the most cost-effective monophasic standard strength (21 day) preparation. 

 
Ethinylestradiol 35 mcg / noresthisterone 500mcg (Brevinor®)
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First Choice
Green

Monophasic standard strength (21 day preparation).

 
Ethinylestradiol 20mcg / desogestrel 150mcg (Gedarel® 20/150, Alenini®, Mercilon®)
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Second Choice
Green

Monophasic low strength (21 day preparation).

Gedarel® 20/150 is the most cost-effective preparation.

 
   
Ethinylestradiol 30mcg / norethisterone 1.5mg (Loestrin 30®)
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Second Choice
Green

Monophasic standard strength (21 day preparation).

 
   
Ethinylestradiol 20mcg / gestodene 75 mcg (Millinette® 20/75, Femodette®, Juliperla®, Sunya®)
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Third Choice
Green

Monophasic low strength (21 day preparation).

Millinette® 20/75 and Juliperla® are the most cost-effective options.

 
   
Ethinylestradiol 30mcg / desogestrel 150mcg (Gedarel® 30/150, Marvelon®, Cimizt®)
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Third Choice
Green

Monophasic standard strength (21 day preparation).

Gedarel® 30/150 and Cimizt® are more cost-effective than Marvelon®.

 
   
Ethinylestradiol 30mcg / gestodene 75 mcg (Millinette® 30/75, Femodene®,Sofiperla®, Katya®)
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Third Choice
Green

Monophasic standard strength (21 day preparation).

Millinette® 30/75 and Sofiperla® are the most cost-effective options. 

 
   
Mestranol 50mcg / norethisterone 1mg (Norinyl-1®)
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Formulary
Green

Monophasic standard strength (21 day preparation).

 
   
Ethinylestradiol 35 mcg / noresthisterone 1mg (Norimin®)
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Formulary
Green

Monophasic standard strength (21 day preparation).

 
   
Ethinylestradiol 35 mcg / norgestimate 250 mcg (Cilique®, Cilest®, Lizinna®)
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Formulary
Green

Monophasic standard strength (21 day preparation).

Cilique® is the most cost-effective option. 

Cilest® will be discontinued with effect from July 2019. Current supplies are expected to last until mid-July 2019.

 

 
   
Combined Hormonal Contraceptives (Logynon ED®)
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Formulary
Green

Phasic standard strength (28-day ‘Every day’ preparation).

 
   
Combined Hormonal Contraceptives (Synphase®)
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Formulary
Green

Phasic standard strength (21 day preparation).

 
   
Ethinylestradiol / levonorgestrel phased pill (TriRegol®, Logynon®)
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Formulary
Green

Phasic standard strength (21 day preparation).

TriRegol® is more cost-effective than Logynon®.

 
   
Ethinylestradiol 30mcg / levonorgestrel 150mcg (Microgynon 30 ED®)
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Formulary
Green

Monophasic standard strength (28-day ‘Every day’ preparation).

Microgynon 30 ED® is more cost-effective than Femodene ED®

 
   
Ethinylestradiol 30mcg/drospirenone 3mg (Yasmin®)
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Restricted Drug Restricted
Brown

Restricted use for women who are unable to tolerate alternative combined oral contraceptives.

APCO January 2011.

 
   
Combined Hormonal Contraceptives (Evra)
(Transdermal patch)
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Restricted Drug Restricted
Brown

Evra® patches should be restricted for use in women who are likely to comply poorly with combined oral contraceptives. 

 The Scottish Medicines Consortium (September 2003).

 
   
Combined Hormonal Contraceptives (NuvaRing®)
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Restricted Drug Restricted
Brown

Second or third line option contraceptive when other methods have proved unacceptable.

APCO July 2009.

 
   
07.03.01  Emergency contraception
07.03.01.02  Co-cyprindiol
07.03.01.03  Phased formulations – standard dose 30 micogram oestrogen to top
07.03.01.04  Low dose oestrogen – 20 microgram ethinylestradiol
07.03.01.05  Transdermal (standard strength)
07.03.01.06  Vaginal rings (low strength
07.03.01.07  Copper intra-uterine devices
07.03.02  Progestogen-only contraceptives to top
07.03.02.01  Oral progestogen-only contraceptives
Levonorgestrel 30mcg (Norgeston®)
(Oral progestogen-only contraceptive)
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Formulary
Green
 
   
Norethisterone 350mcg (Noriday®)
(Oral progestogen-only contraceptive)
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Formulary
Green
 
   
Desogestrel
(Oral progestogen-only contraceptive)
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Formulary
Green

Prescribe generically.

Cerazette is 3.5 times more expensive than generic. 

APCO April 2020.

 
   
07.03.02.02  Parenteral progestogen-only contraceptives
Etonorgestrel (Nexplanon®)
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Formulary
Green

Provides contraception for up to 3 years. 

APCO September 2010. 


MHRA/CHM advice (June 2016):

There have been rare reports of Nexplanon® implants reaching the lung via the pulmonary artery. An implant that cannot be palpated at its insertion site should be located and removed as soon as possible; if unable to locate implant within the arm, the MHRA recommends using chest imaging. Correct subdermal insertion reduces the risk of these events.

 
Link  MHRA: Reports of implant device in vasculature and lung
   
Medroxyprogesterone Acetate (Depo-Provera®)
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Formulary
Green

Intramuscular injection.

 
   
Medroxyprogesterone acetate (Sayana Press®)
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Formulary
Green

Subcutaneous injection.

 
   
07.03.02.03  Intra-uterine progestogen-only contraceptive
Intra-uterine Progestogen Only System (Levosert®)
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Formulary
Green

For women requiring contraception for up to 4 years.

NB. Levonorgestrel-releasing intra-uterine devices vary in licensed indication, duration of use and insertion technique—the MHRA recommends to prescribe and dispense by brand name to avoid inadvertent switching.

Heavy Menstrual Bleeding: For women requiring HMB treatment for up to 4 years. 

APCO March 2018.

 
   
Intra-uterine Progestogen Only System (Mirena®)
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Formulary
Green

Contraception: For women requiring contraception for up to 5 years. Levonorgestrel-releasing intra-uterine devices vary in licensed indication, duration of use and insertion technique—the MHRA recommends to prescribe and dispense by brand name to avoid inadvertent switching.

Heavy Menstrual Bleeding: For women requiring HMB treatment for up to 5 years in line with local Care Pathway and Referral Criteria

Adjunctive progestogen in HRT treatment: in line with Oxfordshire HRT formulary and treatment guidance. Licensed for 4 years for HRT use. 

APCO January 2016. 

 
   
Intra-uterine Progestogen Only System (Jaydess®)
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Restricted Drug Restricted
Brown

As an alternative to Levosert/ Mirena if:

  • The woman has previously used Mirena IUS and experienced
    • discomfort
    • unacceptable symptoms
    • troublesome (symptomatic) ovarian cysts
  • Loss of periods is unacceptable to the woman but heavy periods precludes use of copper IUD.
  • History of breast cancer (for consultation at specialist contraception clinic and following involvement of oncologist)
  • Woman wishes to avoid hormones because of unacceptable side effects with hormones previously.
  • Failure at time of fitting to dilate internal os sufficiently for Mirena Jaydess IUS may be fitted because of narrower diameter.

APCO March 2018

 
   
07.03.03  Spermicidal contraceptives
07.03.04  Contraceptive devices to top
07.03.04  Intra-uterine devices
Intra-uterine Contraceptive Devices
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Formulary
Green

Funded by Public Health - as per Family Planing Association Guidelines.

 
   
Intra-uterine Contraceptive Devices (Flexi-T® + 300)
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Formulary
Green

Funded by Public Health - as per Family Planing Association Guidelines.

 
   
Intra-uterine Contraceptive Devices (Flexi-T® 300)
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Formulary
Green

Funded by Public Health - as per Family Planing Association Guidelines.

 
   
Intra-uterine Contraceptive Devices (GyneFix®)
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Formulary
Green

Funded by Public Health - as per Family Planing Association Guidelines.

 
   
Intra-uterine Contraceptive Devices (Load® 375)
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Formulary
Green

Funded by Public Health - as per Family Planing Association Guidelines.

 
   
Intra-uterine Contraceptive Devices (Nova-T® 360)
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Formulary
Green

Funded by Public Health - as per Family Planing Association Guidelines.

 
   
Intra-uterine Contraceptive Devices (T-Safe® CU 380 A)
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Formulary
Green

Funded by Public Health - as per Family Planing Association Guidelines.

 
   
Intra-uterine Contraceptive Devices (TT 380 Slimline®)
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Formulary
Green

Funded by Public Health - as per Family Planing Association Guidelines.

 
   
Intra-uterine Contraceptive Devices (UT 380 Short®)
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Formulary
Green

Funded by Public Health - as per Family Planing Association Guidelines.

 
   
Intra-uterine Contraceptive Devices (UT 380 Standard®)
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Formulary
Green

Funded by Public Health - as per Family Planing Association Guidelines.

 
   
07.03.05  Emergency Contraception
07.03.05  Hormonal methods
Levonogrestrel (Levonelle® 1500)
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First Choice
Green

Levonelle® remains the first line choice of emergency contraception in patients.

Available in certain pharmacies following consultation with a pharmacist. 

 
Ulipristal (EllaOne®)
(Emergency contraception)
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Restricted Drug Restricted
Brown

For use as emergency contraception for patients 72-120 hours post unprotected intercourse and when an intra-uterine device is not appropriate.

 APCO November 2009. 

 
   
07.04  Drugs for genito-urinary disorders
07.04.01  Drugs for urinary retention to top
07.04.01  Alpha-blockers
Tamsulosin Hydrochloride
(Modified-release capsules)
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First Choice
Green

For benign prostatic hyperplasia.

 
Indoramin (Doralese®)
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Formulary
Green

Please note that Tamsulosin M/R capsules are first line.

 
   
Prazosin
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Formulary
Green

Please note that Tamsulosin M/R capsules are first line.

 
   
07.04.01  Parasympathomimetics
Bethanechol Chloride (Myotonine®)
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Formulary
Green
 
   
07.04.01.02  5-Alpha reductase inhibitors
07.04.02  Drugs for urinary frequency, enuresis, and incontinence
07.04.02  Urinary incontinence to top
Tolterodine
(Standard-release tablets)
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First Choice
Green

First-line choice in line with The Management of Over Active Bladder Syndrome Guidelines.

APCO March 2017.

 
Fesoterodine (Toviaz®)
(Modified-release tablets)
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Second Choice
Green

Second-line option if tolterodine tolerated but not effective and mirabegron is contra-indicatedin line with The Management of Over Active Bladder Syndrome Guidelines.

APCO March 2017.

 
Link  OCCG Leaflet: Patient information on trial of stopping overactive bladder drug
   
Mirabegron (Betmiga®)
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Second Choice
Green

In line with The Management of Over Active Bladder Syndrome Guidelines.

  • Second-line option if antimuscarinic drugs are contra-indicated
  • Third-line option if antimuscarinic drugs have not been effective and mirabegron is not contra-indicated


NB. Mirabegron is contraindicated in patients with severe uncontrolled hypertension (systolic blood pressure ≥180 mm Hg or diastolic blood pressure ≥110 mm Hg, or both). Blood pressure should be measured before starting treatment and monitored regularly during treatment, especially in patients with hypertension. MHRA Oct 2015.

APCO March 2017.

 
Link  MHRA: Risk of severe hypertension and associated CV events with mirabegron
Link  NICE TA290: Mirabegron for overactive bladder
Link  OCCG Leaflet: Patient information on trial of stopping overactive bladder drug
   
Oxybutynin
(Tablet)
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Restricted Drug Restricted
Brown

Oxybutynin should not be initiated for new patients.

People whose treatment with oxybutynin is not recommended in The Management of Over Active Bladder Syndrome Guidelines, but was started within the NHS before this guidance was published, should be able to continue treatment until they and their NHS clinician consider it appropriate to stop.

APCO March 2017. 

 
Link  Medicines for Children leaflet: Oxybutynin for daytime urinary symptoms
Link  OCCG Leaflet: Patient information on trial of stopping overactive bladder drug
   
Oxybutynin Hydrochloride (Kentera®)
(Patch)
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Restricted Drug Restricted
Brown

Restricted for patients with swallowing difficulties in line with The Management of Over Active Bladder Syndrome Guidelines.

APCO March 2017. 

 
   
Solifenacin (Vesicare®)
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Formulary

Amber Traffic Light Suitable for continuation in primary care following specialist initiation for paediatric patients with overactive bladder (tablets and liquid).

Approved subject to MMTC. Tablets are not licensed for use in children but licensed in adults for symptomatic treatment of urge incontinence and/or increased urinary frequency and urgency. The liquid is licensed for neurogenic detrusor overactivity (NDO) in paediatric patients aged 2 to 18 years.  In paediatric patients it is currently used by the specialist team as second/third line therapy following failure of either oxybutynin or tolterodine.

APCO November 2019.

Black Traffic Light Solifenacin should not be initiated for new adult patients.

People whose treatment with solifenacin is not recommended in The Management of Over Active Bladder Syndrome Guidelines, but was started within the NHS before this guidance was published, should be able to continue treatment until they and their NHS clinician consider it appropriate to stop.

Review continued benefit of antimuscarinic therapy and consider switching to tolterodine if this has not previously been tried.

APCO March 2017.

 
   
Trospium
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Restricted Drug Restricted
Brown

Patients currently taking trospium should be allowed to continue with this treatment.

Trospium may be an appropriate choice for patients taking multiple concomitant therapies as it does not interact with drugs metabolised by CYP 450 liver enzymes in line with The Management of Over Active Bladder Syndrome Guidelines.

APCO March 2017.

 
   
Botulinum Toxin A
(Overactive bladder)
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Formulary
Red

In line with Clinical Commissioning Policy 254A

 
   
Duloxetine
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Formulary
Amber Continuation

For stress incontinence following recommendation from specialists only.

Duloxetine should not be prescribed for overactive bladder.

APCO July 2006.

 
   
07.04.02  Nocturnal enuresis
07.04.02  antimuscarinics
07.04.02  beta3-adrenoceptor agonists
07.04.02  botulinum toxin
07.04.03  Drugs used in urological pain to top
Pentosan polysulfate sodium  (Elmiron®)
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Formulary
Red

Specialist use only for treating bladder pain syndrome in line with NICE TA610.

APCO January 2020.

 
Link  NICE TA610: Pentosan polysulfate sodium for treating bladder pain syndrome
   
07.04.03  Alkalinisation of urine
Potassium Citrate
Formulary
Green

Available to purchase over-the-counter for the relief of discomfort in mild urinary-tract infections. 

 
   
Sodium Citrate
Formulary
Green

Available to purchase over-the-counter for the relief of discomfort in mild urinary-tract infections.

 
   
07.04.03  Acidification of urine
07.04.03  Other preparations for urinary disorders
07.04.04  Bladder instillations and urological surgery
Dimethyl Sulphoxide Bladder Instillation 50%
(DMSO)
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Unlicensed Drug Unlicensed
Red

Secondary care use only for symptomatic relief in patients with interstitial cystitis (Hunner's ulcer).

 
Link  Nice Evidence Summary: Interstitial cystitis - dimethyl sulfoxide bladder instillation
   
07.04.04  Urological surgery to top
Glycine 1.5%
(Irrigation solution)
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Formulary
Red

Secondary care use only. 

 
   
07.04.04  Maintenance of indwelling urinary catheters
Catheter Patency Solutions
(Chlorhexidine 0.02%)
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Formulary
Green

Brands include Uro-Tainer Chlorhexidine®.

 
Link  MHRA alert: Anaphylaxis risk with chlorhexidine
   
Catheter Patency Solutions
(Sodium chloride 0.9%)
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Formulary
Green
 
   
Catheter Patency Solutions
(Solution R)
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Formulary
Green

Contains Citric acid 6%, gluconolactone 0.6%, magnesium carbonate 2.8% and disodium edetate 0.01%. Brands include OptiFlo R®, Uriflex R®, and Uro-Tainer® Twin Solutio R. 

 
   
07.04.05  Drugs for erectile dysfunction
07.04.05  Alprostadil
Alprostadil (Caverject®)
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Restricted Drug Restricted

Brown Traffic Light  For erectile dysfuction in line with Clinical Commissioning Policy 41E.

APCO May 2016.

Black Traffic Light  For penile rehabilitation following prostate surgery in line with Clinical Commissioning Policy 233C.

APCO November 2012.

 
   
Alprostadil (MUSE®)
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Restricted Drug Restricted

Brown Traffic Light  For erectile dysfuction in line with Clinical Commissioning Policy 41E.

APCO May 2016.

Black Traffic Light  For penile rehabilitation following prostate surgery in line with Clinical Commissioning Policy 233C.

APCO November 2012.

 
   
Alprostadil (Viridal® Duo)
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Restricted Drug Restricted

Brown Traffic Light  For erectile dysfuction in line with Clinical Commissioning Policy 41E.

APCO May 2016.

Black Traffic Light  For penile rehabilitation following prostate surgery in line with Clinical Commissioning Policy 233C.

APCO November 2012.

 
   
07.04.05  Phosphodiesterase type 5 inhibitors
Sildenafil
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Restricted Drug Restricted

Brown Traffic Light  First line treatment for erectile dysfunction. SLS restrictions removed for generic sildenafil. The quantity prescribed for erectile dysfunction should be limited to 4 doses per month in line with Clinical Commissioning Policy 41E.

APCO May 2016.

Black Traffic Light  For penile rehabilitation following prostate surgery in line with Clinical Commissioning Policy 233B.

 
Avanafil (Spedra®)
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Restricted Drug Restricted

Brown Traffic Light For erectile dysfunction in line with Clinical Commissioning Policy 41E.

APCO May 2016.

Black Traffic Light  For penile rehabilitation following prostate surgery in line with Clinical Commissioning Policy 233B.

 
   
Tadalafil
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Restricted Drug Restricted

Brown Traffic Light For erectile dysfunction in line with Clinical Commissioning Policy 41E.

APCO May 2016.

Black Traffic Light  For penile rehabilitation following prostate surgery in line with Clinical Commissioning Policy 233B.

Black Traffic Light For symptoms associated with benign prostatic hyperplasia in line with NICE TA273.

APCO March 2013. 

 
Link  NICE TA273: Hyperplasia (benign prostatic) - tadalafil (terminated appraisal)
   
Vardenafil (Levitra®)
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Restricted Drug Restricted

Brown Traffic Light For erectile dysfunction in line with Clinical Commissioning Policy 41E.

APCO May 2016.

Black Traffic Light  For penile rehabilitation following prostate surgery in line with Clinical Commissioning Policy 233B.

 
   
07.04.05  Papaverine and phentolamine to top
Aviptadil + phentolamine (Invicorp®)
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Restricted Drug Restricted

Brown Traffic Light  Second line treatment for erectile dysfunction equal to Caverject after oral therapies in line with Clinical Commissioning Policy 41E.

APCO July 2018.

Black Traffic Light  For penile rehabilitation following prostate surgery in line with Clinical Commissioning Policy 233B.

 
   
Papaverine
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Formulary
Red

Secondary care use only. Unlicensed indication.

Patients with neurological or psychogenic impotence are more sensitive to the effect of papaverine than those with vascular abnormalities.

 
   
Phentolamine
(Erectile dysfunction)
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Formulary
Red

Secondary care use only. Unlicensed indication.

 
   
07.04.06  Drugs for premature ejaculation
07.05  Drugs used in Gynaecology endocrinology
07.05.01  For ovulation induction
07.05.01.01  Anti-oestrogens
07.05.01.02  Gonadotrophins to top
07.05.03  For ovulation trigger
07.05.04  For withdrawal bleeding
07.05.05  For hirsutism
 ....
 Non Formulary Items
Alfuzosin
(Modified-release tablets)

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Non Formulary
Black

Please note that Tamsulosin M/R capsules are first line.

APCO July 2006.

 
Alfuzosin
(Standard-release tablets)

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Non Formulary
Black

Please note that Tamsulosin M/R capsules are first line.

Not recommended for urinary retention in children due to lack of evidence. 

APCO July 2006.

 
Alprostadil  (Prostin VR®)

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Non Formulary
 
Alprostadil 3mg/g cream  (Vitaros®)
(Erectile dysfunction)

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Non Formulary
Black

For erectile dysfuction in line with Clinical Commissioning Policy 41E.

APCO May 2016.

 
Anethol, Borneol, Camphene, Cineole, Fenchone, Pinene  (Rowatinex®)

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Non Formulary

A terpene mixture claimed to be of benefit in urolithiasis for the expulsion of calculi.

 
Atosiban

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Non Formulary
 
BARD Catheter Trays

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Non Formulary
Black

Not recommended for use as more expensive than components. More cost effective alternatives are available.

APCO January 2014. 

 
Carbetocin  (Pabel®)

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Non Formulary
 
Catheter Patency Solutions
(Solution G)

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Non Formulary
 
Combined Hormonal Contraceptives  (BiNovum®)

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Non Formulary
 
Combined Hormonal Contraceptives  (Femodene® ED)

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Non Formulary

Microgynon 30 ED® is more cost-effective than Femodene ED®.

 
Combined Hormonal Contraceptives  (Minulet®)

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Non Formulary
 
Combined Hormonal Contraceptives  (Qlaira®)

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Non Formulary
Black

No evidence of clinical benefit over other more cost effective alternatives. No long term safety data.

APCO July 2011.

 
Combined Hormonal Contraceptives  (Triadene®)

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Non Formulary

Logynon®, TriRegol® and Synphase® are more cost-effective. 

 
Combined Hormonal Contraceptives  (Tri-minulet®)

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Non Formulary
 
Combined Hormonal Contraceptives  (TriNovum®)

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Non Formulary
 
Dapoxetine  (Priligy®)

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Non Formulary
Black

Not recommended for premature ejaculation.


APCO March 2014. 

 
Darifenacin  (Emselex®)

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Non Formulary
Black

Not recommended for use.

APCO May 2011.

 
Dinoprostone  (Propess® 10mg)

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Non Formulary
 
Distigmine Bromide  (Ubretid®)

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Non Formulary
 
Doxazosin

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Non Formulary
Black

Not recommended for benign prostatic hypertropphy.

APCO September 2009. 

Link  UKMI Q&A: How should conversion between doxazosin formulations be carried out?
Link  UKMI Q&A: What is the evidence comparing doxazosin XL with standard doxazosin?
 
Dutasteride and Tamsulosin  (Combodart®)

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Non Formulary
Black

No evidence of advantage over finasteride or that patients failing on finasteride will benefit from dutasteride. 

APCO September 2011. 

 
Econazole  (Gyno-Pevaryl®)

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Non Formulary
 
Ethinylestradiol 20 mcg / drospirenone 3 mg  (Eloine®)

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Non Formulary

Not cost-effective. 

 
Etonorgestrel  (Implanon®)

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Non Formulary

Discontinued in October 2010 and replaced by Nexplanon®, but some women may have the implant in place until 2013.

 
Fenticonazole  (Gynoxin®)

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Non Formulary
 
Flavoxate  (Urispas 200®)

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Non Formulary
 
Gemeprost

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Non Formulary
 
Imipramine

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Non Formulary
 
Intra-uterine Progestogen Only System  (Kyleena®)
(Levonorgestrel 19.5 mg)

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Non Formulary
Black

Contraception for up to 5 years. Not part of OCC contraception service.

APCO July 2018.

 
Ketoconazole 2%  (Nizoral®)
(Vaginal cream)

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Non Formulary
 
Lactic acid  (Balance Activ Rx®)

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Non Formulary
 
Lactic Acid  (Relactagel®)

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Non Formulary
 
Misoprostol
(Gynae)

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Non Formulary

Unlicensed use. 

 
Misoprostol vaginal delivery system  (Mysodelle®)

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Non Formulary

For induction of labour.

 
Nomegestrol acetate and beta estradiol  (Zoely®)

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Non Formulary
Black

Not recommended as there are more cost effective alternatives available.

APCO May 2013.

 
Norethisterone  (Micronor®)
(Oral progestogen-only contraceptive)

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Non Formulary

Discontinued 2017.

 
Norethisterone enantate  (Noristerat®)

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Non Formulary

Provides contraception for 8 weeks; it is used as short-term interim contraception e.g. before vasectomy becomes effective.

 
Nystatin
(Vaginal candidiasis)

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Non Formulary

Nystatin pessaries and nystatin vaginal cream have been discontinued.

 
Oestrogens, Topical  (Ortho-Gynest®)

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Non Formulary
 
Ospemifene  (Senshio®)

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Non Formulary
 
Oxybutynin Intra-vesical
(5mg/30ml)

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Non Formulary
 
Penile implant

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Non Formulary
Black

For erectile dysfuction in line with  Clinical Commissioning Policy 41E.

APCO May 2016.

 
Propantheline

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Non Formulary
Black

There is no evidence to support the efficacy of propantheline and it should not be used.

See The Management of Over Active Bladder Syndrome Guidelines.

APCO March 2015.

 
Propiverine  (Detrunorm®)

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Non Formulary
Black

Not recommended for use.

APCO May 2011.

 
Replens MD®

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Non Formulary
 
Ritodrine  (Yutopar®)

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Non Formulary
 
Sodium Citrate 3%
(Irrigation solution)

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Non Formulary
 
Solifenacin and Tamsulosin  (Vesomni®)

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Non Formulary
Black

Not recommended due to lack of evidence.

APCO September 2014.

 
Spremicidal Contraceptives  (Ortho-Creme®)

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Non Formulary
 
Spremicidal Contraceptives  (Orthoforms®)

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Non Formulary
 
Sylk®  (Paraben-free personal lubricant)

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Non Formulary
Black

In line with Clinical Commissioning Policy 88D. Can be purchased over the counter.

APCO January 2011.

 
Tadalafil  (Cialis®)

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Non Formulary
 
Tadalafil once daily

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Non Formulary
Black

Not recommended as no head-to-head trials to compare efficacy or new safety issues.

APCO March 2009.

 
Tamsulosin Hydrochloride
(Modified-release tablets)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

Please note that Tamsulosin M/R capsules are first line.

APCO September 2011. 

 
Terazosin

View adult BNF View SPC online View childrens BNF
Non Formulary

Please note that Tamsulosin M/R capsules are first line.

 
Tolterodine
(Modified-release capsules)

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Non Formulary
Black

Standard-release tablets are first-line for overactive bladder treatment.

See  The Management of Over Active Bladder Syndrome Guidelines.

APCO March 2017. 

 
Vacuum pumps

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Non Formulary
Black

For erectile dysfuction in line with Clinical Commissioning Policy 41E.

APCO May 2016.

For penile rehabilitation following prostate surgery in line with Clinical Commissioning Policy 233B.

APCO November 2012.

 
Yes® water-based intimate lubricant

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

In line with Clinical Commissioning Policy 88D. Can be purchased over the counter.

APCO July 2014.

 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Red: Medicines which should only be prescribed in secondary care by a specialist.  

Amber Continuation

Amber Continuation: Medicines which should be initiated or recommended by a specialist for continuation in primary care. The specialist must notify the GP that the prescribing responsibility has been transferred.   

Amber Shared Care Protocol

Amber Shared Care Protocol: Medicines which are appropriate to be initiated and stabilised by a specialist, once stabilised the medicine may be appropriate for responsibility to be transferred from secondary to primary care with the agreement of a GP and a formal ‘shared care’ agreement. The shared care protocol must be approved by the Area Prescribing Committee Oxfordshire (APCO).   

Green

Green: Medicines which are suitable for initiation and ongoing prescribing within primary care.   

Brown

Brown: Medicines which should only be prescribed in restricted circumstances.  

Black

Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.  

OCCG Green

not used  

netFormulary